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Everything You Ever Wanted
to Know About Sex Change*
*but were afraid to ask

Last updated in 1997

Hormones

Hormones: When Reality Takes A Break

by: Wendi Pierce *

Recently I saw a cartoon in Tapestry that took a little while to sink in. The cartoon was a take-off on the drug addiction awareness ads running in many national publications. The original ad went something like this, "This is Crack, this is your brain on crack". This cartoon substituted "Premarin" for "Crack" and showed the brain image as flowers, rainbows, etc.. At first I thought it amusing and a novel parody but the more I thought about it, the more serious it became.

The mind and what it perceives govern our lives. We as members of the "gender community" have decided to explore our minds and likewise our inner desires. In many cases, we are now able to express that inner self publicly. We have allowed our "inner self" to come out into the light of day, to be expressed openly and we are, "on a grow", as a good friend of mine puts it.

However, we need to be clear headed and rational in our exploration of this inner self. We need to be able to evaluate ourselves clearly and choose the right path at each and every fork in the road, less we wake up some day realizing that where we are now is not the place that we started out heading toward. Worse yet we may have no way to go back.

Everyone knows the physical effects which hormones produce. However, a powerful influence which may not be apparent to some is the effect of hormones on our mind. Most people do not realize that these chemicals have a dramatic effect on our mind as well as our bodies. If you want proof, just ask any "natural" woman how her mood, attitudes, and ability to function varies at times due to her natural cycle. In the case of a person on large doses of hormones being used to cause a gender change combined with the natural hormones present of the person's original gender and one may end up with a mental state the equivalent of a bottle of nitroglycerin ready to blow at the slightest jarring.

For those who choose to experiment with hormones in a non-controlled environment, the situation is extremely dangerous. Supervision is the key here. Not just physical supervision which is usually provided by a family doctor or an endocrinologist but psychological supervision by a professional trained in "gender therapy". A professional who is keenly aware of the mind altering properties of these drugs and a professional trained to observe subtle attitude shifts. One needs this kind of care to prevent the worst from happening. It would be horrible to wake up one day and realize that during a long sleep we now have mutilated our body, have lost the support of our family, are broke, without a job and on the verge of suicide.

Don't get me wrong, I'm not negative on hormones. I feel that they can perform nothing short of a miracle to modify one's physical and mental being thereby correcting what I feel is a major birth effect, but the key is to use these chemicals in a controlled environment. A good friend of mine related to me how he (she) was on a rocket ship for about six months. At the beginning of the period she began a program of hormone treatment wanting to become more feminine to "see how it felt". After about four months on a fairly high dosage program (5-7mg/day), she was seriously contemplating a trip to Colorado for reassignment surgery. Within a month after she stopped treatment, she was still positive about being able to express her internal "second self" but surgery was no longer an immediate goal. She may someday have surgery but has decided that for now, the immediate gains would not be worth the price which must be paid, i.e. the loss of her family and career.

For others hormones and the effect on their minds had meant the opposite. The effect seems to have been to allow these people to more clearly see how comfortable they are in their new chosen gender. After hormone treatment their path became clear and the internal conflict which had been a life-long strife was resolved.

Hormone therapy can both resolve and create problems and should be administered with this in mind. In most cases, I would advise that the person discontinue use for a period after the initial effects have begun to take hold. This break will allow for the "hormone high" to subside and give the person a time to reevaluate where they want to go. A period of a month or so won't hurt any long term progress that is desired and it will give the person's mind a chance to return to their pre-hormone thought patterns. Therapy during this period is very important, and an in depth consultation should precede the continuance of hormone therapy. Questions such as "what am I gaining and what am I giving up should be asked. If the answers are not conclusive, then continuance of hormone therapy should be postponed until some point of resolution of there questions is possible. If hormone therapy is reinstituted at this time, it may conceal the true inner self and the replies may only be those reflecting the person's "hormone high".

Successful "gender therapy" is the desired result and proper application of the methods and therapy (including hormone therapy) are the tools. These tools should be used under the close supervision of a trained gender therapist. If the methodology described here is followed, I feel that the person has a better chance of attaining a true peace and contentment with the true inner self.

* Copyright 1990 by Wendi D. Pierce. All rights reserved. Permission to reprint this article in publications of the gender community is hereby granted provided that this article is published in it's entirety including this notice and credit is given to the author.

HORMONES

by Melanie Anne

The subject of hormones is a hot one. These chemicals are essential to feminization and transformation, and yet they are very poorly understood. Medical experts around the country stand firmly behind the information they supply. The problem is, they all disagree! So what's a girl to do? How can learn the REAL story on hormones? Well, as a small step in that direction, I am opening the discussion here today. I would like to hear REAL LIFE comments from those who are on or have taken hormones about the effects and side effects they experienced. Pills vs. Injections, emotional effects, physical complications, desired physical effects. In short, let's gather our OWN data base of information from real people who are actually USING hormones.

The most important thing to remember is that

HORMONES ARE DANGEROUS!!!!!

They are not candy, they are not recreational drugs, they are not womanhood in a bottle. So, in the traditional warning: "Don't try this at home!" You could kill yourself.

I know a doctor here in LA who will give you whatever you want. Just tell him the dose and he'll inject it or sell you the pills. Now THAT's REALLY dangerous!!! Unless you know what you are doing, you might just end up on a slab or a mental vegetable.

You see, one of the gravest dangers of hormones is blood clotting (or Thrombosis). When clots form, they might be so small as to be undetectable. Yet if that clot is dislodged and thrown into the blood stream, it can lodge in the heart, lungs, or brain, and cause everything from heart attack to stroke.

And then there is the liver. Anyone taking hormones by pills needs to have regular checkups to test for impaired liver function. Injections bypass the liver, going directly into the bloodstream, but pills are processed by the liver and the wrong dose can permanently damage it. The liver does not regenerate. Once it is damaged, it STAYS damaged for the rest of your life.

So, a physicians care is ABSOLUTELY ESSENTIAL for ANYONE on ANY KIND of hormones. Now, many of us ignore that, trying to get on the 'mones without anyone knowing, or afraid that a doctor would not prescribe them. And even those of us on professional care often change dosages to our own idea of what they should be because we are dissatisfied with our own progress.

That last point is pertinent to me. My doctor saw me through all my hormone therapy and all the way through surgery. He had always told me that after surgery, you need to drop your dose. But, right after surgery, he retired and moved out of the area with no forwarding address. He turned over his records to another doctor, but the new doctors were just general practitioners, not Transsexual experts. So, I switched to my S.O.'s HMO plan. The doctor there was very accommodating. He looked at my dosages and said, "I don't have much experience with hormones, but these levels look about right." So he just rubber-stamped my pre-surgery levels, not even knowing they were supposed to come down.

Doctor Biber gives you an "ad lib" or "for life" prescription for HIS recommended dosages: .05mg Estinyl daily, 10mg Provera one week per month. He does not believe in "cycling" like with birth control pills, for example, where the standard prescription is three weeks on and one week off everything for a 28 day "cycle".

Now the dosages I was taking from my HMO were .25mg Estinyl (5 times as high as Biber recommends) PLUS 5.0mg Premarin on a 25 day on, 3 day off cycle. Then 10mg Provera on the last 10 days of the cycle. Quite a difference!!! But, this was all prescribed by my doctor. So, who is right? What is right? Well, that brings me back to the purpose of this article: to find out! To start the effort off, here is a portion of a letter I wrote an online friend earlier in the month about my attempt to find the proper hormone type and dosage. "I have been dissatisfied with my bust development. I knew it felt like there was more of an effect when I first started on injections three years ago, but I don't want to go back on them because I had some severe mental effects. That's why I switched to pills after two months. Before the injections, I used B.C. pills. I used the 1/50 kind, which I understand to be 1mg of Provera and either .05mg or .5mg Estinyl. Now, after about 60 days of that, I developed trouble breathing and a general lethargy and tiredness and weakness. I stopped and the effects went away. I was not sure if they were caused by the pills or not.

On the dosages I had from my doctor, which ended up at .25mg Estinyl and 5.0mg Premarin daily on a 25 day on 3 day off cycle with 10mg Provera on the last ten days, I had no ill effects. But I also never got that breast tenderness I had experienced with the injections and only ended up an A cup. I had heard that Estinyl was 10 times as powerful as Premarin, meaning the 5.0 Premarin amounted to .5mg Estinyl. But the two drugs also have slightly different effects. The Premarin sneaks past the glands and is not noted as an increased Estrogen level, but the Estinyl is noted and before surgery, the body increases Testosterone to counteract the Estinyl. But the Estinyl is what increases the breasts best, so it is a catch 22. But AFTER surgery, you don't need the sneaky Premarin, and you can use all Estinyl with no backlash, thereby getting the good effects.

After surgery, you are supposed to lower your dose. Well, my doctor moved out of the area after 16 years here, just after surgery. So I went to the HMO and they just rubber stamped my old prescriptions. So I wanted to lower the overall dose, but get more effects. So, I stopped the Premarin, (the equivalent of .5mg Estinyl, and added .25 to the Estinyl to bring it up to .5 total. That way, it cut down the effective dose by 33% but added more of the good stuff. I also switched to a daily dose of 5mg Provera, amounting to the same overall amount taken over the full month.

Well, I got a BIG boost in development (especially around the nipples from the Provera). But the weakness and breathing problems came back. So, I am in my 3 day off cycle now. I stopped the Provera and Estinyl. I will go back on the regular cycle except I will use the .5mg Estinyl daily and only use the Provera on the last 10 days as before at 10mg daily. I cannot be sure if it is the higher estrogen level or the Provera that causes the problem, nor which one is the cause of the extra development, but this last test should clear that up. I'll let you know what happens.

Okay, so there's an opening salvo in the war against Hormone Ignorance. If YOU have any REAL experience or knowledge of hormones, PLEASE take the time to make that information available to the community, so we can be all that we want to be at the smallest possible risk to our health.

HORMONES

by Cheryl

I took my first Premarin in June of 1992, two weeks after going full-time. I had planned it all six months earlier. After finishing up a computer contract in Baton Rouge, I went to the Be All in Detroit. It had been building for a while, to where I couldn't stand not being Cheryl for more than three or four days. I knew quite a few people in the Midwest, from the gender groups and BBSs. The Be All was my first convention, though. I had a great time, and met a number of people who were living full-time, both pre- and post-op. I knew this was very much what I wanted, more than anything.

Two weeks later, I met a friend who I had been talking to online for quite a while. She gave me a hundred 1.25 mg Premarin that she had from Mexico. We stopped at a restaurant, and she gave me a long lecture on hormones. She told me to use what she had given me to take to a doctor to show that I could get them. I sort of half agreed. Ten minutes after leaving her, greedy little me took her first Premarin tablet. About an hour later, driving home, I took another one. It was wondrous, this was something my body had been missing all my life.

For about two months, I was so happy to be living full-time and having hormones. I didn't go to see a therapist or an endocrinologist, though. I was living in a small town, and didn't know where to go. Several weeks after running out of Premarin, I went into a severe mood depression. I hadn't known that stopping suddenly could cause that. When I described my symptoms to a woman friend, she said, it sounds like PMS to me. For about a month, I went into a deep withdrawal from everyone and everything. I stayed in the house most all of the time, only going out to get food, and didn't talk to anyone. The depression started over hormone withdrawal, but continued because I felt that I was dead in the water with my transition. It seemed like I would never succeed in transition.

Eventually my friend Janice called. She wondered why no one had heard from me. I poured my heart out to her. I hated my life, and if I had to live as a male, I'd sooner die. She talked me into coming to Chicago and seeing her. Janice is very motherly, a sweet person. I feel like I owe her my life. She and another girl set me up to see a doctor to get a prescription. I got my first real prescription, for Premarin and Provera. I also got a shot from the doctor. I don't know how much was physical and how much psychological, but after getting the injection, I felt the weight of the world lift from me. For the first time in nearly two months, I could see daylight again.

I wasn't over my depression yet, but I was much better. What brought me around was a spiritual experience. I had been trying to transition using male thinking. I was doing it with my head rather than my heart, and it wasn't working. I came to the point where I had to give up the male completely. It was a submission, that I knew I had no control over this thing, and gave up completely, turning it over to the Feminine inside me. At the same time I came to an acceptance that this was me, the male had to die so that the woman could live. A wondrous thing happened. I felt a suffusion of feminine strength, rather weak at first but growing stronger over time, like a seed sprouting from the earth. I felt a love, a nurturing and connection, that I'd all but forgotten from childhood. At the time I started reading Marion Woodman on the Feminine, and felt an instant empathy with what she was describing. Marion describes the Feminine as, not a Goddess exactly, but a connection with the universe, a way of seeing. The Feminine is bountiful, but has her terrible aspect too if shunted aside and ignored. This made perfect sense to me.

For the next several months, I did everything I could to nurture this new wonderful freedom. Old habits die hard, though, and I tried to control things again. I have a strange dominance/submissive streak in me. While sexually I'm submissive, sometimes a strong independent dominance comes through in non-sexual situations. I think it may have been a cover to hide from myself that I really am a submissive.

Anyway, I decided that I was going to take control again, I knew what I was doing. I doubled my Premarin dose, added Spironolactone, and over the next six months began taking extremely high and dangerous dosages. At one point, I was taking 7.5 mg of Premarin, 0.5 mg of Estinyl, 3 mg of Estrace, a day, along with wearing the Estraderm patch and taking Provera and Spironolactone, and getting my weekly shot. I had confused 0.05 mg of Estinyl with 0.5 mg, which is only given to males with prostate cancer. It was an enormous dosage, more than 10 times what is commonly considered a safe regimen.

Needless to say, I got to be a sick little kitty. Severe headaches, wild and terrible mood swings, physical nausea, my body was rebelling. I blamed it all on the Provera, so I stopped taking that. (g) On top of that, I had several ounces of simsellian pot that a boyfriend had given me, which made me feel better, I thought.

I had an almost unlimited source of hormones, but even I recognized it was much too much. I was going crazy. I'm generally a pretty mellow, thoughtful person, but I turned into superbitch. It was like having incredibly bad PMS all the time. My whole system was completely out of whack, and I started going into suicidal depressions again. My boyfriend of the time said I was going to blow out my liver.

Gradually, over several months, I started cycling down, to where I was taking about 5 mg a day of Premarin, which was much better. Instead of leaving it at that, though, I started doing my own injections of Estradiol Valerate and progesterone. Not knowing what I was doing, I overdosed on that. My hands and arms broke out in sores. At first I thought I might have AIDS. I've engaged in unprotected anal sex on a number of occasions in the past, and there was a time when I would go to bed with just about any man who would be nice to me and appreciate me as a woman, it was the only way I knew to validate my identity. I was so scared, I was afraid to go to have it checked for a week. Finally I went to the clinic. As it turned out, I was HIV negative, and it was probably due to progesterone poisoning.

When I had my testosterone checked, there was hardly any to measure, I was way below a nontranssexual woman's level. Over this period of six months or so, I'd gone first sterile, then impotent. Which was fine by me, except that I knew I needed to retain the ability to orgasm. Only now, four months later, is that coming back a little bit.

I've been following the doctor's regimen now, and while I still have PMS and mood swings, it's nowhere near as severe. I don't consider suicide an option anymore. I'm going to pull through this, and I'm going to get back to that happy state I've experienced before in transition.

What did I get out of all the overdosing? Well, maybe my breasts grew a little faster than they might have otherwise, but I risked my life for a few months development. Mainly, though, what I got was expensive piss. The body can absorb only so much, and the rest is excreted, putting an extra strain on the liver.

So to any sister contemplating upping the dosage, I say don't. It's not worth the risks. We're in this for the long haul, and nature can't be hurried along that quickly. I know I don't want to die a male, and it would be ironic to kill myself with estrogen overdose, not that I'd appreciate the irony. The steady course is the safe one.

Book Review

"Hormones - The Woman's Answer Book"

Book by
Lois Jovanovic, M.D.
and
Genell J. Subak-Sharpe, M.S.

If you are looking for a book that gives you hard numbers regarding dosages and effects of hormones for replacement therapy or transsexual pre-surgical therapy, this is not it. But if you want a wide ranging and easy to read exploration of the bigger picture: how hormones and the organs of the endocrine system interrelate, you will find plenty of meat here.

Many of us enter hormone treatments and even complete our surgeries unaware of what we are really doing to our bodies. Of course we all want soft skin, less body hair, and larger breasts, but what else do hormones do to our bodies?

In this book, the authors carefully explain how each independent organ is connected to all the others through the interplay of hormones. Some glands secrete tropic hormones that have no direct on the body but serve only to stimulate and regulate other organs to produce hormones that do act upon the body proper. Once desired levels are reached, a complex feedback system triggers the instigator organs to either cease producing the tropic hormones, or triggers other glands to produce tropic hormones that in turn tell the instigator gland to stop producing ITS tropic hormone. All in all, the endocrine system is not to be thought of as just testosterone or estrogen.

Of note is the great detail the authors draw in regard to the glands of the brain - hypothalamus, pituitary, and pineal, and how they are related to the thyroid, parathyroid, and adrenal glands. This keen and easily upset network controls body functions and conditions from skin, hair and nail growth, temperature, appetite, intestinal function, to the tremendous emotional effects. On this last point, the book is perhaps weak in its concentration on the physical effects, while the emotional and psychological areas or only lightly touched upon.

Fortunately, the style is fairly conversational, and though at times it gets bogged down in technicalities, these passages are usually brief and segue quickly into more understandable material.

One technique of interest is that although the focus is on the female system, whenever certain hormones also appear in the male, this is noted and briefly explored, showing how sometimes the same hormones can have radically different effects on each sex.

An aspect of the book that I found personally very helpful was the sprinkling of useful tidbits of information throughout the book that described symptoms of hormone use that I had experienced but not connected with hormones. For example, from a clear complexion, over my four years of hormone therapy, I developed a heavily freckled face, mostly on the cheeks and under the eyes. I assumed it was the result of electrolysis until I read that this is caused by large doses of estrogens and even occurs with some regularity in women using birth control pills. I had used skin bleaches to some success, but the freckles always cam back. According to the book, once hormone doses are lowered, the freckles may remain, but then they may be successfully bleached with fade creams. So, now that I am on lower levels since surgery, I will give that a try again and fully expect it to work. Definitely useful information in my case. Of course there are many other little side notes of that nature that you are sure to find good preventative or curative information.

In conclusion, it is simply a dangerous idea to jump into hormone therapy without an understanding of just what one is doing to one's body. Doctors frequently leave us in the dark, preferring to tell us to trust their experienced judgment. NEVER DO THIS!!!! Some hormone doctors are experts in their fields while others are nothing more than quacks. Before you begin hormone therapy, or even more so if you are currently in therapy, take the time to learn about what you are doing to yourself. A good place to start is with this book.

--Hormones - The Woman's Answerbook is available in paperback in better bookstores at a list price of $4.99 U.S., $5.99 Canada.

You can purchase the complete 194 page book for only $19.95!

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